Provider Demographics
NPI:1598919102
Name:PAGOTO, JENNIFER LEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:PAGOTO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SAGAMORE RD APT 1I
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-1558
Mailing Address - Country:US
Mailing Address - Phone:914-202-8804
Mailing Address - Fax:
Practice Address - Street 1:25 SAGAMORE RD APT 1I
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-1558
Practice Address - Country:US
Practice Address - Phone:914-202-8804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007366-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor